CPT 35671 Popliteal-Tibial Bypass Reimbursement | OpenPayer

Summary & Overview

CPT 35671: Popliteal to Tibial/Peroneal Bypass with Synthetic Graft

CPT code 35671 denotes a peripheral arterial bypass procedure using a synthetic graft to bypass an occlusion in the popliteal artery and connect to a tibial or peroneal artery in the calf. This operation is a key limb-salvage intervention for patients with critical limb ischemia or significant peripheral arterial disease when autologous vein conduit is unavailable or unsuitable. Nationally, the code represents high-acuity vascular surgery with implications for hospital resource utilization, device use, and post-operative care.

Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for when the procedure is applied, the typical sites of service, and operational considerations tied to use of synthetic graft material. The publication outlines common billing modifiers and coding relationships where available, and summarizes typical documentation elements required to support medical necessity.

This analysis provides benchmarks and policy-relevant considerations for payers and providers at a national level, highlights coding and billing nuances for vascular bypass procedures, and frames the clinical indication and care setting for CPT code 35671. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare35671CPTperipheral-arterial-bypasspopliteal-arterysynthetic-graftvascular-surgerylimb-salvagecritical-limb-ischemia

Billing Code Overview

CPT code 35671 describes a surgical bypass using a synthetic graft to reroute blood flow around a blockage in the popliteal artery of the calf, connecting the graft to a distal tibial or peroneal artery. This procedure restores arterial circulation to the lower leg when native vessel repair or autogenous conduit is not feasible.

Service type: Peripheral arterial bypass using synthetic graft

Typical site of service: Hospital operating room or vascular surgery suite, often performed by vascular surgeons or cardiovascular specialists for limb-threatening ischemia or critical peripheral arterial disease.

Clinical & Coding Specifications

Clinical Context

A 72-year-old patient with progressive right calf claudication at rest after failing conservative therapy and smoking cessation presents with an ankle-brachial index of 0.45 and imaging-confirmed occlusion of the distal superficial femoral artery extending into the popliteal artery with downstream disease of the tibial vessels. The vascular surgeon schedules an open extra-anatomic bypass using a synthetic prosthetic graft to bypass the diseased segment of the popliteal artery and create an anastomosis to a tibial or peroneal target artery. Preoperative workflow includes arterial duplex and CT angiography for anatomic planning, perioperative medical optimization (antiplatelet and statin therapy), informed consent documenting indications and risks, and marking of the operative leg. Intraoperative workflow includes general or regional anesthesia, surgical exposure of the popliteal and selected tibial/peroneal artery, proximal and distal control, construction of proximal and distal anastomoses using a synthetic graft (e.g., PTFE), completion angiography or Doppler assessment of graft patency, hemostasis, and wound closure. Postoperative care includes monitoring for limb perfusion, anticoagulation or antiplatelet therapy per protocol, wound care, and surveillance duplex imaging to assess graft patency and detect complications such as graft thrombosis, infection, or distal embolization. Typical site of service is an inpatient operating room or an ambulatory surgery center for select low-risk patients. Service type: open vascular bypass surgery of the popliteal-to-tibial/peroneal arterial segment using a synthetic graft.

Coding Specifications

Modifier	Description	When to Use
`62`

CPT 35646: Aorto-Femoral Bypass with Synthetic Graft

CPT-35654-AXILLARY-FEMORAL-BYPASS-NON-VEIN-GRAFT

CPT 35654: Axillary to Femoral Bypass Using Non-Vein Graft

CPT-35647-AORTO-FEMORAL-BYPASS-SYNTHETIC-GRAFT

CPT 35647: Aorto-Femoral Bypass with Synthetic Graft

CPT-35650-AXILLARY-ARTERY-BYPASS-SYNTHETIC-GRAFT

CPT 35650: Axillary Artery Bypass with Synthetic Graft

CPT-35632-ILIAC-TO-CELIAC-SYNTHETIC-GRAFT-BYPASS

CPT 35632: Iliac-to-Celiac Synthetic Graft Bypass

CPT-35642-CAROTID-TO-VERTEBRAL-ARTERY-BYPASS-SYNTHETIC-GRAFT

CPT 35642: Carotid-to-Vertebral Artery Bypass with Synthetic Graft

CPT-35661-FEMORAL-FEMORAL-BYPASS-SYNTHETIC-GRAFT

CPT 35661: Femoral–Femoral Bypass with Synthetic Graft

CPT-35606-SUBCLAVIAN-ARTERY-BYPASS-SYNTHETIC-GRAFT

CPT 35606: Subclavian Artery Bypass with Synthetic Graft

CPT-35663-ILIAC-ARTERY-CROSS-FEMORAL-BYPASS-SYNTHETIC-GRAFT

CPT 35663: Iliac Artery Cross-Femoral Bypass with Synthetic Graft

CPT-35626-AORTIC-TO-SUBCLAVIAN-INNOMINATE-CAROTID-BYPASS-GRAFT

CPT 35626: Aortic-to-Subclavian/Innominate/Carotid Bypass with Synthetic Graft

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Taxonomy Code	Specialty	Notes
`207VG0200X`	Vascular Surgery	Primary specialty performing open lower extremity bypass procedures.
`207L00000X`	General Surgery	General surgeons with vascular training may perform lower extremity bypass in some centers.
`207RH0000X`	Thoracic and Cardiovascular Surgery	Cardiac/vascular surgeons who perform peripheral bypass procedures.
`2080P0206X`	Interventional Cardiology	Less commonly performs surgical bypass but involved in endovascular alternatives and hybrid procedures.
`2084P0800X`	Interventional Radiology	Typically provides diagnostic and endovascular treatments; may assist with imaging or hybrid interventions.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.213`	Atherosclerosis of native arteries of the extremities with intermittent claudication, bilateral legs	Atherosclerotic disease causing popliteal occlusion and claudication prompting bypass.
`I70.233`	Atherosclerosis of native arteries of the extremities with ulceration, bilateral legs	Advanced peripheral artery disease with tissue loss that may require bypass to restore perfusion.
`I70.239`	Atherosclerosis of native arteries of the extremities with gangrene, bilateral legs	Critical limb ischemia with gangrene indicating need for revascularization such as popliteal-to-tibial bypass.
`I74.3`	Embolism and thrombosis of arteries of the lower extremities	Acute arterial occlusion that may be managed with bypass if thromboembolectomy or endovascular therapy is not suitable.
`I70.222`	Atherosclerosis of native arteries of the extremities with rest pain, right leg	Rest pain from severe peripheral artery disease indicating urgent revascularization.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35721`	Thromboendarterectomy, femoral, with patch graft	May be performed proximal to popliteal bypass to treat inflow disease before or during bypass.
`35666`	Bypass graft, with vein; femoral to below-knee popliteal, synthetic graft	Related bypass of adjacent segments; alternative graft configurations for lower extremity revascularization.
`36011`	Introduction of needle/catheter into artery, radiological supervision and interpretation	Used for intraoperative or preoperative angiography to define anatomy or assess graft patency.
`93925`	Duplex scan of arterial inflow and outflow, lower extremity arterial studies with duplex	Common pre- and postoperative surveillance test to evaluate limb perfusion and graft patency.
`37186`	Intravascular thrombolysis, percutaneous, any method	May be used pre- or postoperatively to treat acute graft thrombosis or distal emboli as adjunct to surgical management.

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